Herpes zoster is a common infection caused by reactivation of the varicella zoster virus. In most patients the disease runs a painful but benign course with complete recovery. A unique case of trigeminal ophthalmic herpes zoster presented to The Toronto Hospital, Toronto, Ontario. This patient had a unilateral full thickness defect of scalp and skull with secondary osteomyelitis and opacification of the eye. After appropriate medical therapy and surgical debridement, reconstruction was undertaken using a latissimus dorsi free flap and split thickness skin grafts. This achieved a satisfactory reconstruction with obliteration of the diseased tissue. On follow-up several months later, there was erosion through the central area of the skin graft. This appears to be secondary to trauma caused by the patient frequently scratching the area, and that the original defect likely had a factitious component of the same etiology.